In the 10 years he spent driving an ambulance in Atlanta, former paramedic Kevin Hazzard rescued people from choking, overdoses, cardiac arrest, gunshot wounds and a host of other medical emergencies.

He frequently found himself practicing medicine in unsafe settings, either along the side of a highway as cars whipped past, or at the scene of an assault, where either the patient or the spectators might have weapons. "There are a lot of situations like that where it's just not practical to wait for it to be completely safe and you gotta just try to weigh the odds," Hazzard tells Fresh Air's Terry Gross.

In his new book, A Thousand Naked Strangers, Hazzard chronicles his experiences as a paramedic — and explains how it is that so many of his patients came to him partially clothed.

"There's just the huge range of people for whatever reason — whether it's mental illness or just had way too much fun last night — find themselves out in the street partially or completely naked and need to be dealt with in one way or another," Hazzard says.

But Hazzard says that even when he saved a life, his patients weren't always grateful. "Just as you're expecting a thank-you, someone says, 'Hey, when you pulled me off that balcony that I was dangling from, you ripped my shirt!' "

Interview Highlights

On why he always moves out of the way of ambulances

There's a presumption that when you see an ambulance or a firetruck or a cop car that the person behind [the wheel] is a professional — they've been trained and they know. I received zero training. My first job was with a private ambulance service ... taking people to and from appointments. There was no training program. There was really no hiring process. They never verified they actually had my EMT numbers. They asked. I said, "Yes." They believed me; they gave me a job. ...

So I showed up that first morning, and my partner handed me the keys. I just assumed he was going to be driving. So we go to breakfast and within a few minutes we get a call, and the next thing I know I'm racing down the street and he's like, "Turn your lights on! Flip over! Cross the double yellow line! Switch back! Blow your horn!" My friends will tell you, I'm a horrible driver, so me behind this 15,000-pound ambulance screaming down the street, cars peeling out of the way, immediately removed all [my] confidence in people coming at me with sirens. I move now, really fast.

On why respiratory callscan bethe most rewarding

Respiratory calls are really, really common — which was great because there are few things that you can do outside of the hospital that take someone from near death to looking at you and saying, "Do I still need to go?" And respiratory is one of those calls. We ran so many of them on everything from infants to the elderly, it was great. Everybody thinks shooting is exciting, "Oh, man, I'm going to run to this shooting, and I'm on my way!" And it's crazy. There are cops there and police helicopters and it's madness, but there's really nothing for you to do. That's really a job for the surgeons. Whereas a respiratory call, that person is in acute distress and they are going to die, you can see it in their face, and they know it and you know it. And you just happen to have this bag full of tricks that you get to kneel on their floor and talk to them and calm them down and slowly begin to give them one medication after another. Sometimes it doesn't work, sometimes you throw the book at them and they're still just about as dead as when you found them, but oftentimes you can make a huge difference in that person's life, and it's both rewarding and exciting because you wouldn't be there if you didn't want to open your bag and start throwing medicine at people.

On treating "speedball" overdoses, in which the patient has mixed heroin and cocaine

The one that can be the trickiest is the person who has overdosed. So you arrive, and they have all the signs of a heroin overdose, and so you have Narcan, which immediately reverses some of the effects, basically the central nervous system effects of the heroin. So, the heroin, when there's too much of it, it essentially tells your brain, "Hey, there's no reason to breathe, just relax, you're good." And that's how people die. So you show up, there's a guy with needles, brown powdery substance, he's blue, and you think, "Oh, heroin overdose, this is no big deal, I've done this 10,000 times." And you give him some Narcan thinking, "Hey, I'm just going to make him breathe." Now the heroin's gone and all that cocaine is still there, and he pops up and he's like, "Hey! What did you do to my heroin?" And now you've got this very large, very angry, very confused person running around with a head full of coke, and you're usually in the backseat of a car or crammed into a tiny little bathroom, or a bathroom stall in a restaurant, and all of a sudden this person pops up, and invariably they're bigger than you and stronger than you and they're half-naked and sweaty, so you can't get a grip anyway. Those get ugly in a hurry.

On Do-Not-Resuscitate orders

If you think about it, [at] Thanksgiving you can't even get all your family members to agree on whether they want fresh or canned cranberry sauce, right? I mean, the simplest decision in the world, and you will get four brothers who will fight to the death because they all have a different opinion, and then add to that, now, that decision is what to do if mom drops on the floor. A lot of times, it kind of depends on who the first person is to arrive. Does she live with one of the sons who wants her to be revived? Does she live with one of the children who doesn't? Even if there's a DNR that has been signed, oftentimes people can't find it. So then you have to say, "OK, we don't have, technically speaking, a valid DNR, so we have no choice but to work," and the family will get angry with you and say, "No, no, no, that's not what she wanted!" But you can't prove to me that's not what she wanted, and how do I know that you don't have a sister who is on her way right now who knows that there's no DNR and who is gonna come flying through that door and wonder why we're not doing anything?

On delivering babies

Delivering babies is a huge mess in an ambulance. Hospitals are really well-suited for it. So it was such a tricky thing, because when you got one of those calls, your first reaction would sort of be dread: "Oh, no, there's so much I'm going to have to do here, this is such a circus." Hopefully they were at least in an accessible place, not in a car on the highway, which just really complicates everything. It's one of those things that it's not good until it's all over with. Don't forget, these are people who are enduring a natural childbirth, so they aren't happy to see us. There's no joking with a woman who is way deep into a natural childbirth and is going to do it on the living room rug. She's not in the mood to smile or necessarily even be cooperative. ... All of a sudden there's this child and everybody is smiling. ... It wasn't one you always looked forward to, but it was one in the end that everybody always seemed to enjoy.

On how he knew it was time to retire from being a paramedic

There were a couple little hints and warning signs. I ran a shooting one day, and I got too close to the person and stepped on a piece of their skull. And I didn't realize it until I got home the next morning, and it was stuck in the tread of my boot, and I thought it was a stone. And I pulled it out and it was skull fragment. I sort of laughed. My wife was horrified, and the look on her face let me know that, oh, wow, my outlook has swung in a weird direction and that's troubling.

Those things happen little by little over time, and I guess there are hints and warnings that, hey, you're being a little too cavalier about what you're doing. But the moment that it hit me ... it was a woman who she was caught in bed with her son-in-law by her daughter, and the son-in-law jumped out, and the daughter beat the mother with a bat. And we got there and she was really badly injured, and she was on the floor at our feet, and this crazy scene is happening all around us — helicopters and cops and this patient who desperately needed our help — and I remember yawning, and it was probably 2 in the morning and I yawned. It wasn't like I didn't care whether or not good things happened to this woman. I had done it so many times that there was a certain ho-hum nature about it, and there can be nothing ho-hum about trying to save someone's life. And when you begin to think, "Well, I've done this before and I'll just do it again and I'm just doing a job," that's when you make mistakes. And that was the first real indication to me that, man, I've been at this too long and I need to go ahead and get out.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

Transcript

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. You know that sinking feeling when you see an ambulance on your block, and you're wondering, who are they coming for? For about 10 years, my guest, Kevin Hazzard, was one of the guys arriving in the ambulance. In 2004, he became an EMT, an emergency medical technician. After taking more classes, he was able to take on greater medical responsibilities as a paramedic. He says he practiced medicine in streets, bathrooms, living rooms, elevators, construction sites and even a rooftop. He revived people who had OD'ed, helped rescue people whose bodies were shattered by car accidents, tried to bring people back whose hearts had stopped, delivered babies and had to deal with unusual cases, like a guy who had intentionally nailed himself to the wall. Before becoming an EMT, Hazzard graduated from The Citadel military college, then worked as a reporter at a daily newspaper in Marietta, Ga. He's now a freelance writer and is writing for TV.

Kevin Hazzard, welcome to FRESH AIR. So before we talk about your work as an EMT and as a paramedic, can you just tell us a little bit the differences between what an EMT can do and what a paramedic can do?

KEVIN HAZZARD: Yeah, you know, it's changed a little bit. There's a really concerted effort, which is great 'cause it's long-overdue, to help not only standardize the training that EMS workers go through but also to try to improve it because medicine's changing. And EMS, kind of since its inception, has been this thing that nobody's truly understood or really known what to do with. And so it's suffered a bit from that. But - so now it's a little bit different than when I got into it. But the basics, you know, still bear out. Essentially, an EMT is, you know, the junior member of the ambulance duo. Generally speaking, the EMTs, you know, they can start IVs. They can bandage. They can splint. They can do CPR. There are a few medications that they can give. And, you know, that training is anywhere from six to nine months, whereas a paramedic is an additional 18 months. And that's where you get into the medications, the intubation, cardiology, you know, being able to work the - you know those famous, you know, paddles - clear, pop. And so a paramedic is a much more - much more involved level. And, you know, the strange thing about it is that a paramedic has more autonomy than anyone other than a physician. So it's a really weird job because you get there, and there's kind of nowhere for you to go. I mean, you could - you know, some people go to become a nurse for money or, you know, the stability for working for a hospital. But that's such a different job that, you know, it's not comparable in any way. So paramedic is really a very interesting - a very interesting place to be.

GROSS: Before you worked with emergency medical services, had you ever called an ambulance or been in one or needed one for a loved one?

HAZZARD: (Laughter). Well, there's no other way - yeah, my mother's 40th birthday, a friend of mine found a bottle of whiskey in the basement. And two hours later, he rode his bike over to my house to say, Kevin's passed out in the woods and you've got to go get him. So they called an ambulance. I had - I had a little too much to drink. So they brought me to the hospital, essentially just to keep an eye on me. I was naturally pumping my own stomach the entire time.

GROSS: (Laughter).

HAZZARD: It was good birthday - (laughter).

GROSS: So...

HAZZARD: It was an awesome birthday present.

GROSS: Did they do the right thing in calling an ambulance?

HAZZARD: Yeah because I think at that point I had been, you know, lying face-first in the dirt for (laughter) a really unnatural period of time. And I was pretty well empty but, you know, still convulsing. So they said all right, so we've got to do something. And I think - I think a neighbor's parents looked out and, you know, saw my sneakers sticking out of the bushes and were like, what the heck?

GROSS: So in your work doing EMS, you first worked for a private company, taking patients from nursing homes to dialysis or to the hospital. Then you worked for the city of Atlanta, directly for a hospital there that sounds like it served mostly poor people.

HAZZARD: Well, yeah, as far as, you know, working for the hospital, Grady is an extraordinary place. I mean, there's no other word for it. You know, if you live in the southeast, you know of it. You know, it's akin to Cook County or Bellevue. It's this incredible trauma center, incredible burn unit. But because it's, you know, it's the public hospital, you know, it's the place that all indigent patients go to. And, you know, it's also the biggest. And so they receive a lion's share of those kind of patients who, you know, quite frankly are always in some sort of need. It makes it an interesting place because on the one hand, it attracts these incredibly skilled providers. But on the other, you know, it's - it always retains a bit of a circus atmosphere because of that.

GROSS: So you were told that it was your responsibility to answer any call, even if somebody was calling 'cause they had a toothache, even if somebody was trying to, like, freeload and get, like, a ride downtown.

HAZZARD: Yes.

GROSS: It was your duty to answer the call. Did you get a lot of people who really should not have been calling an ambulance?

HAZZARD: (Laughter) I can hear 10,000 paramedics around the country banging their hands on tables right now. Yeah, that's really common, you know. Someone decides, hey, I need a ride to an appointment at the hospital - 'cause, you know, a lot of hospitals have clinics. So they'll call 911 and say they have chest pain or even, you know, something simple like, oh, my foot hurts; I need to go. And then there are people who - they're just kind of looking for attention. They're a little bit lonely. They're, you know, kind of a little bit hapless. But, you know, they'll call for a nightmare. They'll wake up. Oh, my chest is really beating hard. Well, what was going on? Well, I just had this crazy nightmare. And I woke up, and my chest was really beating hard. You know, and if that person wants to go, you've got to take them. That's just the way the law's written in Fulton County, regardless of why you call. So we would go out to people with nightmares or a toothache, which you'd try to explain. Hey, this isn't going to end well for you. You're going to spend 12 hours in a waiting room and then get sent home with a referral to a doctor's appointment. But they'll - they'll try their luck.

GROSS: So one of the things you had to do was learn how to drive an ambulance. And what was it like the first time you drove with your sirens on?

HAZZARD: Petrifying. And you - there's a presumption that, like, when you see an ambulance, that there's someone - or a fire truck or a cop car - that the person behind it is a professional. Like, they've been trained, and they know - I received zero training. My first - (laughter) - my first job was with a private ambulance service. And there's, you know, sort of a kaleidoscope of services out there that range from, you know, 911 to the private services that sort of take people to and from appointments. And that was my first job, taking people to and from appointments. And there was no training program. I mean, it was really no hiring process. They never verified that I actually had my EMT numbers. They asked. I said, yes. They believed me. They gave me a job. I had to go out and buy my own uniform. But - so I showed up that first morning. And my partner handed me the keys. I just assumed he was going to be driving. And so we go to breakfast, and within a few minutes, we get a call. The next thing I know, I'm racing down the street. And he's like, turn your lights on. Flip over - you know, cross the double yellow line. Switch back. Blow your horn. And I'm - (laughter) - my friend will tell you. I'm a horrible driver. So me behind this, like, 15,000-pound ambulance screaming down the street, cars peeling out of the way, it immediately removed all confidence in people coming at me with sirens. I move now really fast.

GROSS: (Laughter). Did you learn how to do a better job over time?

HAZZARD: I did. Well, if you get a job with a 911 service, they take you through this course. It's - I think they call it EVOC. And, you know, you swirl through some cones, which - really not practical at all. You know, and they show you how to back up. And they give you, you know, one of those horrible videos that's - is meant to petrify you of a paramedic who was sent to jail for killing somebody in a wreck. And so it - you know, it's sort of a sobering moment when you realize, oh, wow, there are repercussions if I do this wrong. But still, it's just sort of expected that if you know how to drive, you can figure out how to drive with a siren on.

GROSS: I always get a little panicky when there's a fire truck are an ambulance behind me 'cause, like, oh, my god. I've got to pull over. Where am I going to pull over? (Laughter). What do I have to do to not, like, crash this thing?

HAZZARD: Well, you'd be shocked how many people do crash. People will whip off the road and hit a tree or whip into oncoming traffic. And you - so over time, you really learn to lay off the sirens because you understand that people are going to either A, ignore you, or B, panic. And the ones that panic, they usually - gosh, it ends in - you just hate to see it happen because you can - you can see the person looking in the mirror, looking at the road. And you think, oh, don't do it. Oh, don't do it. And then, pop, they hit a tree or something. And then you've got to stop. People will whip off the road and hit a tree or whip into oncoming traffic. And you -so over time, you really learn to lay off the sirens because you understand that people are going to either, A - ignore you, or, B - panic. And the ones that panic, it usually - it ends - you just hate to see it happen 'cause you can see the person looking in the mirror, looking at the road, and you think, oh, don't do it. Oh, don't do it. And then - pop - they hit a tree or something, and then you've got to stop.

GROSS: And then at that point is that job no. 1 for you, or is your job no. 1 for you to report to the 911 caller?

HAZZARD: I guess it would depend on what I was responding to, you know? If there was - 'cause there are a lot of, you know, really critical calls and there are a lot of calls that are not quite so critical. And if I saw a bad wreck that I had inadvertently caused, that would become my personal priority. I'd, you know, just ask for another ambulance to be sent to my call.

GROSS: So of all the types of calls that you would get, is there a most typical one?

HAZZARD: I think it probably depends on where you live. What I understand from friends, they say chest pain was the most common thing in New York City. In Atlanta - and I think it's a mixture of our climate, you know, some of the aging buildings, the population. Respiratory calls are really, really common, which was great because, you know, there are few things that you can do outside of the hospital to take someone from near death to looking at you and saying, do I still need to go? And respiratory is one of those calls. And so, you know, that - we ran so many of them everything from infants to the elderly. It was great. You know, everybody thinks shooting is exciting - oh, man, I'm going to run this shooting, you know, and I'm on my way. And it's crazy, there are cops there, and a police helicopter and it's madness. But there's really nothing for you to do. That's really a job for the surgeons, whereas a respiratory call, you know, that person is in acute distress and they are going to die. I mean, you can see it in their face, and they know it and you know it, and you just happen to have this bag full of tricks that you get to kneel on their floor and talk to them and calm them down and slowly begin to give them one medication after another. And, you know, sometimes it doesn't work. Sometimes you throw the book at them and they're still just as about dead as when you found them. But oftentimes you can make a huge difference in that person's life, and it's both rewarding and exciting because, I mean, you wouldn't be there if you didn't want to open your bag and start throwing medicine at people.

GROSS: You had to treat a lot of overdoses, and I learned some interesting things about overdoses reading your book. Like, I never really understood what made a speedball so potent when the heroin starts to wear off. So, you know, a speedball is a combination of heroin and cocaine. Would you describe why that could be not only a deadly mix but a really difficult high in the long run?

HAZZARD: Yeah, heroin and cocaine have different half-lifes, I guess you could say. And so taken in combination, it sort of, you know, somehow this crazy mix of up plus down, which gives you even - which is probably where most of us live anyway - but it's a distorted version of even. And the heroin unfortunately wears off faster. So people have a tendency to be living this, you know, nice, happy high and then all of a sudden, the heroin's gone and you just - you've got a head full of cocaine. And, you know, anyone who's had any experience around people who have done it, you can see right away that that has a tendency to get kind of ugly toward the end. And so at the end of this high when someone's been up all night and, you know, it's been really great, all of a sudden it's just grinding teeth and sweat and anxiety and frustration. And they're really high on top of it, and you know, that leads to - usually leads to them getting kind of violent and angry.

GROSS: So is that when you're called in? Like, at what point were you called in for speedball overdoses? Or is that when they're totally, like, knocked out and perhaps dying?

HAZZARD: Yeah, it depends. I mean, the worst was if you had someone who'd taken too much heroin. So - you know, 'cause if it's just the right mixture, what we would be called in is the point at which the high turns ugly and you have this guy who's kind of rampaging in his house or in his apartment or, you know, down the street, I mean, in the mall. There's all kinds of, you know, people's high turns bad on all kinds of places. The one that can be the trickiest is the person who's overdosed. So you arrive and they have all the signs of a heroin overdose. And so you have Narcan, which immediately reverses some of the effects, basically the central nervous system effects, of the heroin. So the heroin, when there's too much of it, it essentially tells your brain, hey, just, no reason to breathe, just relax, you're good. And then that's how people - you know, that's how people die. And so you show up. There's a guy with needles. Brown, powdery substance. He's blue. And you think, oh, heroin overdose, this is no big deal, I've done this 10,000 times. And you give him some Narcan thinking, hey, I'm just going to make him breathe. Now the heroin's gone and all that cocaine is still there, and he pops up and he's like, hey, what'd you do to my heroin? And now you've got this (laughter) very large, very angry, very confused person running around with a head full of coke. And it - you know, and you're usually in the backseat of a car or crammed into a tiny little bathroom or a bathroom stall at a restaurant, and all the sudden this person pops up. And invariably, they are bigger than you and stronger than you and they're half naked and sweaty so you can't get a grip anyway and - those get ugly in a hurry.

GROSS: Just when you were expecting a thank you.

HAZZARD: (Laughter). Oh, that's always the case. Just as you're expecting a thank you, someone says, hey, when you pulled me off that balcony I was dangling from, you ripped my shirt.

GROSS: Seriously, did someone tell you that?

HAZZARD: Yeah. Early one morning, I arrived - my partner, she's brand-new, and she gets - we get a call for a person dangling from a balcony, and she pulls the ambulance too close. So we're both looking up at this person dangling directly above us. I said, you've got to back up. If she drops, she's going to land on us. So she backs up and I jump out. I think she was on the third floor. So this cop and I run upstairs all - you know, three flights of stairs, get up there, find her door locked, of course. So we kick it down, which is not easy to do. It's a new apartment building with a big steel door. We get inside, find her luckily still dangling. We grab her, drag her over the edge, sedate her - 'cause she was really high - get her tied down to our stretcher, bring her to the hospital. And the next morning when I showed up at work, the supervisor pulled me aside and said, hey, you remember that girl from last night? I said, yeah. He said, yeah, she's coming after us for $75 dollars for a torn blouse.

GROSS: If you're just joining us, my guest is Kevin Hazzard, who spent 10 years as an emergency medical technician, as an EMT, and then as a paramedic, and he's written a new memoir called, "A Thousand Naked Strangers." Let's take a short break then we'll talk some more. This is FRESH AIR. break.

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GROSS: This is FRESH AIR, and if you're just joining us, my guest is Kevin Hazzard. And we're talking about the 10 years that he spent as an EMT and then as a paramedic. So he was the one who - sometimes he drove the ambulance, he was the guy who showed up in the ambulance to administer emergency medical services. Now he's written a memoir called "A Thousand Naked Strangers." "A Thousand Naked Strangers" - were most of the people who you had to meet naked?

HAZZARD: A lot of them are. These kinds of things never happen at a convenient moment. You know, there's no really good time to get a car wreck or to get hurt. And so especially people at home, you know, they're - you catch them in all kinds of compromising positions. And then there's just a huge range of people that, for whatever reason - you know, whether it's mental illness or, you know, just had way too much fun last night - find themselves out in the street partially or completely naked and need to be dealt with in one way or another. So there's - yeah, literally, there are many people naked. But metaphorically, you know, also practically all of them are.

GROSS: A lot of people have do-not-resuscitate orders. And if you're working with somebody in a nursing home or a hospital, you have easy access to those papers. But somebody could have a DNR and have cardiac arrest at home. And they might be alone; they might be with people who don't know whether they have a DNR or not. So what are you supposed to do as a paramedic when you're in that kind of situation where you don't know?

HAZZARD: Cross your fingers. I mean, if you think about it, Thanksgiving - you can't even get all your family members to agree on whether they want fresh or canned cranberry sauce, right? I mean, the simplest decision in the world, and you will get four brothers who will fight to the death because they all have a different opinion. And then, add to that now that decision is what to do if mom drops on the floor. And a lot of times, it kind of depends on who the first person is to arrive, whether - you know, does she live with one of the sons who wants her to be revived? Does she live with one of the children who doesn't? You know, even if there's a DNR that has been signed, oftentimes people can't find it. So then you have to say, OK, we don't have, technically speaking, a valid DNR, so we have no choice but to work. And the family will get angry with you, and say, no, no, no, that's not what she wanted. But you can't prove to me that's not what she wanted. And how do I know that you don't have a sister who's on her way right now who knows that there's no DNR, and who's going to come flying through the door and wonder why we're not doing anything? And I actually got stuck in a parking lot one day. We brought a - it was a man. We brought him out, his wife was with us. You know, they were elderly, and she was beyond being able to talk to us just because she was in such a panic. She said, call my son. So we call her son, and the one son said, he's got to be worked. And the other son, who lived down the street, was adamant that he not be worked, and there was a DNR, the wife just was incapable of finding it, understandably. So we're in the parking lot, and the son pulls up, and he's blocking our ambulance. And he's screaming at us to stop doing what we're doing. We're literally doing CPR on a man in broad daylight in the morning, and he's saying, stop, stop, stop, I have the DNR my hand. What do you - I mean, there's no class that prepares you for a moment like that because now you have to decide, do I leave this guy in the street? I mean, how do I take him off my stretcher and put him back on the floor. You know, it really puts you in an awkward position.

GROSS: Yeah, what did you do?

HAZZARD: Well, we took him because again...

GROSS: You took him to the hospital?

HAZZARD: ... How does it look if - we did, we took him to the hospital because how would it look if an ambulance walked a dead man back up to his apartment, dropped him on the floor, and then walked back down. And, you know, there's people watching. At some point, optics come into play, you know, and you have to say, look, there's no way that we can just dump this guy on the floor. You have to be able to see why that's not good for your father. And usually, people, you know, can be reasoned with. But it's - end-of-life decisions are so tricky, so tricky, even when they shouldn't be.

GROSS: My guest is Kevin Hazzard. His new memoir about his 10 years as an EMT and paramedic is called "A Thousand Naked Strangers." He'll tell us how he learned to tell the difference between people who just thought they were dying and people who were really dying after a short break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Kevin Hazzard. His new memoir, "A Thousand Naked Strangers," is about his work in emergency medicine, first as an EMT, then as a paramedic. He responded to 911 calls in an ambulance and was called on to rescue people from choking, cardiac arrest, drug overdoses, gunshot wounds and car accidents. He also delivered a lot of babies. He gave up the work after 10 years and is now a writer.

You were frequently called into housing projects to deal with emergency medical situations. And I'm wondering if people responded to you - and I'm talking about projects where there was a lot of drugs and a lot of crime, a lot of weapons and, I'm sure, a lot of suspicion about the police. Since you're arriving in a uniform and in an official vehicle, were you seen as the kind of authority that people were suspicious of? Were people ever hostile to you? Or were you seen as the medical person coming to the rescue? And did you get a lot of respect?

HAZZARD: Mostly the latter. For the most part, people understood - especially in a city like Atlanta, where Grady played such an integral role. And people would see that Grady ambulance, and there's just a certain opinion of that hospital, of the people who work there - particular the paramedics who, you know, show up to their houses every day and spend so much time in some of those projects. So for the most part, that was what you got. And even - there were a few houses that I walked into; you could tell immediately that I'm surrounded by bad people, that these are dangerous people. You just - it's a weird vibe that you get in a room full of people who are dangerous. And often, they were - you know, would try to help you out. And, oh, sure, you know, it's my uncle's house. Let me give you a hand. I'll help you carry him out. I think where things got ugly was when you had to flex you're authority - and whether it was somebody saying, hey, I want him to go to this hospital and not this one or, no, I don't want him to go to the hospital, when you really felt that he did. And once you started to say, no, no, this is how we're going to have to do it, then suddenly you became, you know - well, you're just another part of this enforcement machine. And you would see people's faces almost instantly change. And there's a sort of light in their eyes that would go off. And then you realize, oh, wow, this is - this must be what it feels like to be a cop. You know, 'cause you're trying to tell someone, hey, look, you guys have to be quiet because I'm trying to help this woman, and you are crowding around me. And you're screaming. And you're pushing at us. You've got to back up right now. And they would - there would be this sort of hostility switch that would go off. And we certainly found ourselves in those situations plenty, where people - the moment they began to look on you as an authority figure, their entire approach to how they dealt with you changed drastically.

GROSS: When you were sent on an ambulance call, you were told by the dispatcher if it was an unsafe scene. What's an example of an unsafe scene you were sent to?

HAZZARD: (Laughter) Practically all of them. You know, technically, if there's anyone violent, it's unsafe, although many, many, many patients are violent. If there are weapons, it's not safe. But many patients have weapons. A lot of scenes on the highway where, you know, the ambulance is the first thing to get there and it's an overturned car at night or a pedestrian struck in a highway at night and it's just you, at 2 in the morning, standing in the fast lane of the highway, hoping that cars are paying enough attention not to hit you as they're swerving around your ambulance. You know, sometimes, there are active shootings or assaults. You know, I - there are many times where you show up to an assault, and you assume, OK, this is, you know, just two people got in a fight. And by the time you get there, all the neighbors are out. And now there are 15 people who are all screaming at you. And you're the only person there. And half that crowd wants you to help the person who you were called out for. And the other half of that crowd is angry at that person and is going to be angry at you for trying to help them. You know, my - one of my partners and I were called out to a house, and it was an assault. And we got a little too close - 'cause you can - you can stage and stop somewhere and wait for the cops to show up. We got too close. And somebody saw us and said, man, you've got to come with us. Come with us. So, you know, we sort of shrugged and said, all right, whatever. We go inside. And this guy says, my brother, he's on the second floor. You've got to - you've got to get up there. And so we walked to the second floor apartment. And he leads us in. And he immediately disappears. And there on the floor is this guy who's been - who's had his throat cut from ear to ear. And he's in a bad way. And he's sort of eyes wide open, staring at us. And he's gurgling. So we drop to our knees and immediately forget the fact that someone has done this to him. And we just start dealing with him. And right then, a cop comes up and says, the neighbor said the guy's still in the house. So the cop's drawing his gun. And he's walking through this house, poking these doors open one by one with his gun drawn. My partner and I look at each other. And we didn't say it, but the look - the subtext of the look is clear. And that's, if this cop starts to lose this fight, we're going to have to jump in because nobody kills a cop and then leaves two paramedic eyewitnesses just sitting there on the floor.

GROSS: Right.

HAZZARD: Like, you know, and we're - this guy really needs our help. But, you know, I've got a wife who I really want to come home to tonight. So as this cop's kicking in doors, I really had - at that moment wished that we had, you know, been a little more cautious and not just rushed in. But there are a lot of situations like that, where it's just not practical to wait for it to be completely safe. And, you know, you've got to just try to weigh the odds.

GROSS: One of the things you were often called on to do was to deliver babies. And was that a more joyful part of the experience when you were successful because you were bringing new life into the world as opposed to sometimes ushering somebody out of the world when you were unable to save them?

HAZZARD: Delivering babies is a huge mess in an ambulance (laughter). Hospitals are really well-suited for it. So it was really - it was such a tricky thing because when you got one of those calls, you know, your first reaction would sort of be dread. Like, oh, no, there's so much I'm going to have to do here. And this is such a circus. And, you know, hopefully they were in at least - at least an accessible place, you know, not in a car on a highway, which just really complicates everything. But it's one of those things that it's - you know, it's not good until it's all over with - 'cause, I mean, don't forget. These are people who are enduring a natural childbirth. So they aren't happy to see us. You know, there's no - there's no joking with a woman whose way deep into a natural childbirth and is going to do it on a living room rug. You know, she's not in the mood to smile or to necessarily even be cooperative. So you've got to stay on top of them and say, no, no, I know this isn't fun. But you really do need to push. Like, we're at that moment. This needs to happen. And then, all of a sudden, a baby comes out. And everything changes. What went two minutes ago from, you know, four firefighters who are like, man, I don't want to be here and two paramedics who are going, oh, my god, I hope I don't get any of this on me, and a mother who's thinking, I just want this to be over - and all of a sudden, there's this child. And now, everybody's smiling. And it's like, oh, you know, and we start teasing about who you're going to name the baby after. And, you know, they - we wrap him up. We have this little, teeny tiny little beanie cap that you would put on them. And you bring them to the hospital, and then everything - everybody seems to love it. And then you go back and, you know, people - people would, you know, tease you about whatever your tally was, you know, how many had you delivered that year. So it was a strange - it was a strange call because it wasn't one you always looked forward to. But it - but it was one, in the end, that everybody always seemed to enjoy.

GROSS: If you're just joining us, my guest is Kevin Hazzard. He spent 10 years working in emergency medical services as an EMT and then as a paramedic. And now he's written a memoir called "A Thousand Naked Strangers: A Paramedic's Wild Ride To The Edge And Back." Let's take a short break here, then we'll talk some more. This is FRESH AIR.

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GROSS: This is FRESH AIR. And if you're just joining us, my guest is Kevin Hazzard. He's written a memoir about his 10 years in emergency medical services as an EMT and then as a paramedic. His memoir is called "A Thousand Naked Strangers."

In your memoir, you write that you'd run enough ambulance calls that you could tell the difference between those who think they're dying and those who really are. And that you knew how to handle each. How could you tell the difference?

HAZZARD: I think generally speaking the more - the more somebody yells, talks, moves, jumps around, complains that - I always took that to be a good sign. When I walked in a room and someone was just lying there, you know, eyes open sort of slowly breathing, that, to me, always felt very ominous because, you know, a body on the way out has a tendency to know it's on the way out. You know, and you might have a, you know, a respiratory call, but this person is gasping for air and there's, you know, there's frantic movement, but they're just - they're not saying anything. They're just - eyes open - they're not responding to anybody. They - they are - every ounce of their being is working toward getting the next breath. Or someone who's had a stroke and who's kind of sitting there and just, you know, with these wide doll's eyes and just staring off. Or someone who's been shot and, you know, the - it turns out it's not that - a moving target is hard to hit, and so the majority of people who are shot are kind of, you know, they get hit in a limb. Or if it is, you know, they do get hit in the body, it's usually, you know, kind of one. And people would be stunned and scared and angry, you know, and would be, you know, be yelling either at the person who shot them or at you to, you know, you've got to do something man, I've been shot. Whereas the kid who's been shot that one perfect time in the belly and is just bleeding out, he doesn't say a word. He just sits there quite silently and stares at you. So to me, it was all about the person's approach - how they reacted, what they were doing - kind of body language said so much.

GROSS: In spite of the fact that working as a paramedic was incredibly challenging and difficult physically, emotionally, medically, you loved the work for a long time. But at some point you started loving it less and then you stopped loving it, and you started to feel really burned out. Was there an actual turning point for you?

HAZZARD: Yeah, there were a couple little hints and warning signs. I ran a shooting one day, and I got too close to the person, and I stepped on a piece of their skull, and I didn't realize until, you know, I got home the next morning. And it was stuck in the tread of my boot. I thought it was a stone, I pulled it out and it was a skull fragment. And I sort of laughed. And, you know, my wife was horrified, and the look on her face let me know that oh, wow, you know, my outlook has swung in a weird direction, and that's troubling. And, you know, I kind of - those sort of things happened little by little over time. And they're - I guess there are hints and warnings that hey, you know, you're being a little too cavalier about what you're doing. But the moment that it hit me - and I had been sort of angry for a while. My - you know, I had a few partners that quit and I had a rotating cast of irregulars. And, you know, I had a shift that I didn't really care for - so all little things that could be fixed. But those things start to add up after a while when you're dealing with, you know, a really difficult job. And there was a woman who - she was caught in bed with her son-in-law by her daughter. And son-in-law jumped out, and daughter beat the mother with a bat. And we got there, and she was really badly injured. And she was on the floor at our feet, and this crazy scene is happening all around us - helicopters, and cops and this patient who desperately needed our help. And I remember yawning, and it was probably two in the morning, and I yawned. And it wasn't like I didn't care whether or not good things happened to this woman. I just - I'd done it so many times that it was - there was a certain ho-hum nature about it. And there's - there can be nothing ho-hum about trying to save someone's life. And when you begin to think, well, I've done this before, and I'll just do it again, and I'm just doing a job, that's when you make mistakes. And that was the first real indication to me that, man, I've been at this too long, and I need to go ahead and get out.

GROSS: So when you change jobs after you've been doing something a long time, you're also changing identities. And for some people, that's a real crisis because they don't know exactly who they are when they give up that professional identity. Was it hard for you to change your identity from, you know, the guy on the ambulance who rescues people and saves lives to, like, the guy who's trying to write a book? The guy who's trying to get published? The guy who's trying to sell a pilot?

HAZZARD: Yeah, in a big way, you know, people - when you say you're a paramedic people are, like, oh, there's this sort of understanding that oh, you must be a really capable, dedicated, goodhearted person. When you say a writer, people picture either, you know, a hipster looking for single source pour over coffee or, like, a guy who's hiding in his basement, you know, or his mother's basement chopping away on 1,100-page science-fiction novel. So there's kind of, like, a - the look that they give you, like, oh, you're trying to do that. Well, hey, hopefully it works out, you know? Almost as if there's nothing between complete failure and Stephen King, you know?

(LAUGHTER)

HAZZARD: Nothing exists in there. You're either going to, you know, sell 25 million books, or you aren't going to sell any. So it was weird to get used to people looking at you in a totally different light. Even to people who work with you, you know, 10 years as a paramedic, people that, you know, doctors, and nurses and your coworkers - they turn to you and look to you as, you know, like, oh all right, well, Hazzard's done this before, we'll take his word for it, we'll follow his lead. And then you're writing, and you talk to an editor who's, like, so, you know, let me just - let me tell you how the keyboard works. You know, and you got to get used to everybody approaching you with the mindset that you are the new guy who knows absolutely nothing which, you know, to some degree is right. It's weird. It's hard to totally refocus. I can see why not a whole lot of people do it - kind of a scary thing.

GROSS: Well, Kevin Hazzard it's been great to talk with you, and I wish you good luck with your writing career. Certainly, the publication of your memoir is a really solid step in that direction.

(LAUGHTER)

GROSS: So thank you so much for talking with us.

HAZZARD: Thank you, Terry. It's been a real honor.

GROSS: Kevin Hazzard's new memoir is called "A Thousand Naked Strangers." The cinematographer Vilmos Zsigmond, who shot the films "McCabe & Mrs. Miller," "Close Encounters Of The Third Kind" and "The Deer Hunter," died Friday at age 85. We'll hear an excerpt of my 1990 interview with him after we take a short break. This is FRESH AIR. Transcript provided by NPR, Copyright NPR.

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